Abstract
PurposeThis study assessed the incidence of chemotherapy-induced neutropenia and febrile neutropenia (FN) while identifying their associated factors.MethodsA prospective cross-sectional study was conducted among 113 female chemotherapy-naïve breast cancer patients over a 2-year period. Socio-demographic, clinical and haematological data were obtained via semi-structured interviews and from medical case files. Blood samples for complete blood count parameters were collected 2 weeks after each course of chemotherapy. The National Cancer Institute Common Terminology Criteria for Adverse Events version 4.03 was used to assess FN, neutropenia and their severity.ResultsThe incidence of neutropenia and FN among the patients was 31.9% and 5.3%, respectively. Throughout all courses of chemotherapy (n = 502), there were 57 (11.4%) neutropenic episodes with 6.6% mild, 3.4% moderate and 1.4% severe neutropenia. The incidence of neutropenia decreased with increasing chemotherapy courses, with a rate of 14.2% and 4.9% after the first and last course, respectively. Factors associated with the risk of developing neutropenia include increasing age (p = 0.014), Eastern Cooperative Oncology Group performance score ≥ 1 at presentation (p = 0.033) and presence of bone metastasis (p = 0.002).ConclusionOne in three breast cancer patients in this study developed neutropenia while on chemotherapy but no independent risk factors were identified for FN among these patients. This study has, therefore, provided the preliminary data necessary for further independent validation of the identified risk factors for FN in a more robust and well-designed study within our clinical practice setting in Nigeria.
Highlights
Neutropenia, in concert with its major complication, febrile neutropenia (FN), is a major dose-limiting adverse effect of systemic cancer chemotherapy
According to the guidelines by the American Society of Clinical Oncology (ASCO), European Society for Medical Oncology, National Comprehensive Cancer Network and European Organisation for Research and Treatment of Cancer, it is important to evaluate both chemotherapy regimen risk and patient-specific risk factors when evaluating the risk of FN, and the potential need for prophylactic G-CSF use [7,8,9,10]
Majority of the women in this study are either overweight or obese as expected with obesity being a recognised modifiable risk factor for breast cancer [18]. This finding could have a significant impact on the risk and incidence of chemotherapy-induced neutropenia (CIN) and FN due to reduction in the dose of chemotherapy agents as a result of dose calculations based mainly on the use of a maximum bode surface area of 2.2 square meter as generally practised in our setting
Summary
Neutropenia, in concert with its major complication, febrile neutropenia (FN), is a major dose-limiting adverse effect of systemic cancer chemotherapy. CIN, defined as an absolute neutrophil count (ANC) less than 1,500 cell/μl occurring as a side effect of chemotherapeutic regimens, commonly results in FN (occurrence of fever with neutropenia) which requires inpatient evaluations and the use of empirical broad-spectrum antibiotics [1, 2]. The result of this is a reduction in chemotherapy doses and/or treatment delays which leads to worse clinical outcomes in the patients concerned [3, 4]. ASCO guideline recommends primary prophylaxis with GCSF in patients who have an approximately 20% or higher risk for FN based on the patient’s characteristics, specific disease-condition and treatment-related factors while secondary prophylaxis is recommended for patients who experienced a neutropenic complication from a previous cycle of chemotherapy (for which primary prophylaxis was not received), in which a reduced dose or treatment delay may compromise disease-free or overall survival or treatment outcome [7]
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